There is a concern that steroids can increase risk from the novel coronavirus (Covid-19).
Steroids have been associated with an increased risk of mortality in patients with influenza and delayed viral clearance in patients with Middle East respiratory syndrome coronavirus (MERS-CoV) infection.
Although they were widely used in management of severe acute respiratory syndrome (SARS), there was no good evidence for benefit, and there was persuasive evidence of adverse short- and long-term harm.
Injected steroids have also been shown to cause a variable degree of adrenal suppression for at least some weeks.
Intra-articular injections for inflammation – only use for inflammatory joints where there is active synovitis +/- effusion, and consider using lowest clinically effective doses (maximum 40mg depomedrone/ triamcinolone for large joints; 20mg for smaller joints). For children and young people with Juvenile Idiopathic Arthritis, consider using triamcinolone acetonide rather than hexacetonide, particularly if multiple joints injected.
You will be able to request a home visit through NHS 111 who will triage your requests and make arrangements for a local GP to visit you if that is indicated. Please be aware that the GP visiting you may not have access to your clinical record and medical history.
Recommend simple analgesia, activity modification, splinting where appropriate and exercise as first line and in the majority. Only consider if patient has high levels of pain and disability, that has failed first line measures, and continuation of those symptoms will have a significant negative effect on the their health and well-being. Must be supported with guidance related to activity modification and exercise therapy